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Diagnosis of hepatocellular carcinoma

Hepatocellular Carcinoma (HCC)

The diagnosis is sometimes difficult to make and may be suspected in a patient with chronic liver disease who is found to have a high level of a protein, called Alpafoetoprotein (AFP), on a blood test. A CT scan or MRI scan is usually used to look for a mass in the liver. A tumour is not found, or lots of lumps are seen, one of which is larger than the others. One cannot be certain if the larger lump is a HCC, so then the scan is repeated after a suitable period of time. 


If there are suspicions of an HCC in a patient who has not had chronic liver disease, and the image on the scan is not characteristic, a biopsy can be done, but has risks. For example, there is a risk of bleeding and also a risk of spreading the tumour along the line of the biopsy needle. This may impact on the treatment that can be offered.


The Blood test: alpha-foetoprotein (AFP) is a useful serum marker that is raised in approximately two thirds of patients with hepatocellular carcinoma and in much higher levels than in benign liver disease. The fibrolamellar type of HCC does not usually have raised levels of AFP.


The CA19-9 level (see colorectal carcinoma section) is raised in cholangiocarcinoma but the level rises in obstructive jaundice (i.e. when the biliary tree is obstructed) and as this occurs early in cholangiocarcinoma the test is usually of little use.


The definitive proof of the diagnosis is by biopsy (taking a piece of the tumour through a skin needle puncture access) and microscopic examination. Often, the abnormal liver function impacts on the blood’s clotting system and if the coagulation tests in the blood are sufficiently deranged, then the biopsy may be deemed risky and the diagnosis is then based on other criteria.

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